Antimicrobial Resistance in Invasive Bacterial Infections in Hospitalized Children, Cambodia, 2007-2016

Area of Science:

• Medical Microbiology
• Infectious Diseases
• Public Health

Background:

• Antimicrobial resistance (AMR) is a growing global health concern, particularly in low-resource settings.
• Invasive bacterial infections in hospitalized children can lead to severe outcomes and increased healthcare burdens.

Purpose of the Study:

• To investigate trends, mortality rates, and economic costs associated with AMR in pediatric invasive bacterial infections.
• To establish a robust surveillance model for AMR in low-resource healthcare facilities.

Main Methods:

• Analysis of 39,050 cultures from 2007-2016 at Angkor Hospital for Children, Cambodia.
• Identification and antimicrobial susceptibility testing of 1,341 target pathogens.
• Comparison of resistance rates between hospital-acquired and community-acquired infections, and between neonates and non-neonates.

Main Results:

• High AMR rates observed: 82% of Escherichia coli and Klebsiella pneumoniae isolates were multidrug resistant.
• Hospital-acquired isolates showed higher resistance than community-acquired isolates.
• Third-generation cephalosporin resistance in gram-negative bacteremia was linked to increased mortality, ICU admissions, and 2.26-fold higher healthcare costs.

Conclusions:

• High levels of AMR in pediatric invasive bacterial infections represent a significant threat to life and economic stability in Cambodia.
• The study's methodology provides a reproducible surveillance model for AMR in similar low-resource environments.
• Targeted interventions and robust surveillance are crucial to combat AMR in vulnerable pediatric populations.